title: Contextual factors influencing success or failure of emergency department interventions for cognitively impaired older people: a scoping and integrative review.
abstract: OBJECTIVE
  This paper is a report of a scoping review of research on cognitive impairment in older adults who visit Emergency Departments of acute care hospitals, followed by an integrative review that included a quality assessment to determine the effectiveness of interventions for this population.
  
  
  BACKGROUND
  Being old and cognitively impaired in the Emergency Department--a fast-paced intervention system--is a complex phenomenon that challenges many healthcare professionals. The rise in the incidence and prevalence of dementia will have a large impact on healthcare systems.
  
  
  METHODS
  MEDLINE, EMBASE, CINAHL, PsycInfo, AgeLine, Abstracts in Social Gerontology, the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials and Google Scholar between 1990 and 2008, for qualitative or quantitative studies reporting extractable data on delirium or dementia in non-institutionalized older people (65+ years) in the Emergency Department.
  
  
  METHODS
  Titles screened by a project researcher and checked against inclusion criteria by another researcher. Two reviewers completed independent data extraction and synthesis of included studies. Quality assessment occurred using the Critical Appraisal Skills Programme Tools.
  
  
  RESULTS
  Fifteen studies met the inclusion criteria for integrative review. Analysis of these studies indicates that the prevalence of cognitive impairment is high and improvements are needed. Contextual details and relevant features of an appropriate intervention are poorly explained.
  
  
  CONCLUSIONS
  Although the prevalence and incidence of cognitive impairment is recognized, appropriate interventions and programmatic responses remain elusive. Quality improvements require more thorough examination of emergency department context to identify modifiable influencing factors that are transferable across settings.
authors.affiliation: Faculty of Nursing, University of Alberta, Edmonton, Canada. belinda.parke@ualberta.ca
authors.forename: Belinda
authors.initials: B
authors.lastname: Parke
authors.forename: Amy
authors.initials: A
authors.lastname: Beaith
authors.forename: Linda
authors.initials: L
authors.lastname: Slater
authors.forename: Alexander M
authors.initials: AM
authors.lastname: Clarke
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003072:Cognition Disorders / Q000175:diagnosis / Q000453:epidemiology*; D003693:Delirium / Q000453:epidemiology; D003704:Dementia / Q000453:epidemiology; D019049:Developed Countries / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000458:organization & administration* / Q000706:statistics & numerical data; D015577:Geriatric Assessment; D006272:Health Facility Environment / Q000458:organization & administration / Q000592:standards; D006299:Health Services for the Aged / Q000458:organization & administration*; D006801:Humans; D008403:Mass Screening / Q000379:methods; D024802:Nurse's Role; D010043:Outcome and Process Assessment, Health Care; D015995:Prevalence; D058996:Quality Improvement; D012107:Research Design; D012307:Risk Factors